中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 36 Issue 2
Feb.  2020
Turn off MathJax
Article Contents

A clinical analysis of hypoglycemia in patients with liver cirrhosis and diabetes mellitus

DOI: 10.3969/j.issn.1001-5256.2020.02.019
Research funding:

 

  • Received Date: 2019-09-13
  • Published Date: 2020-02-20
  • Objective To investigate the causes of hypoglycemia and the features of clinical indices in patients with liver cirrhosis and diabetes mellitus. Methods A total of 50 patients with liver cirrhosis and diabetes mellitus who were admitted to Beijing YouAn Hospital,Capital Medical University,from January 2017 to June 2019 were enrolled as subjects,among whom 25 patients with one hypoglycemic event were enrolled as experimental group and 25 patients without hypoglycemia were enrolled as control group. Hepatic and renal function,fasting blood glucose,glycosylated hemoglobin,and Child-Pugh class were evaluated for both groups,and the time period and possible causes of hypoglycemia were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results Compared with the control group,the experimental group had significantly lower levels of fasting blood glucose [6. 10( 3. 45 ~ 8. 96) mmol/L vs 8. 12( 6. 18 ~12. 59) mmol/L,Z =-2. 687,P = 0. 007],cholinesterase [3009. 00( 1788. 50 ~ 4439. 50) U/L vs 4936. 00( 4051. 00 ~ 6740. 50) U/L,Z =-3. 095,P = 0. 002),albumin( 32. 02 ± 7. 07 g/L vs 35. 89 ± 5. 49 g/L,t = 2. 161,P = 0. 036),and glycosylated hemoglobin( 6. 97± 1. 64 mmol/L vs 8. 04 ± 1. 78 mmol/L,t = 2. 047,P = 0. 047). Among the patients in the experimental group,36% had Child-Pugh class B cirrhosis and 36% had Child-Pugh class C cirrhosis,and among the patients in the control group,56% had Child-Pugh class A cirrhosis and 40% had Child-Pugh class B cirrhosis; there was a significant difference in Child-Pugh class between the two groups( χ2=8. 786,P = 0. 012). Most of the patients with liver cirrhosis and diabetes mellitus experienced hypoglycemia in the fasting state in the morning and in the daytime,with the main causes of excessive insulin( 44%) and insufficient food intake or calorie supplementation( 40%),and some patients experienced fasting asymptomatic hypoglycemia( 16%). Conclusion Blood glucose monitoring and management should be taken seriously for patients with liver cirrhosis and diabetes mellitus in clinical practice,in order to reduce the occurrence of hypoglycemia.

     

  • loading
  • [1] PFORTMUELLER CA,WIEMANN C,FUNK GC,et al. Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis[J]. J Crit Care,2014,29(2):316.
    [2] BARDAYAN Y,WAINSTEIN J,SCHORR L,et al. Hypoglycemia-simplifying the ways to predict an old problem in the general ward[J]. Eur J Intern Med,2019,60:13-17.
    [3] LEE WG,WELLS CL,MCCALL JL,et al. Prevalence of diabetes in liver cirrhosis,A systematic review and meta-analysis[J]. Diabetes Metab Res Rev,2019,35(6):e3157.
    [4] PETIT JM,HAMZA S,ROLLOT F,et al. Impact of liver disease severity and etiology on the occurrence of diabetes mellitus in patients with liver cirrhosis[J]. Acta Diabetol,2014,51(3):455-460.
    [5] GUNDLING F,SEIDL H,STRASSEN I,et al. Clinical manifestations and treatment options in patients with cirrhosis and diabetes mellitus[J]. Digestion,2013,87(2):75-84.
    [6] Chinese Society of Hepatology and Chinese Society of Infectious Diseases Chinese,Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
    [7] Chinese Society of Diabetes,Chinese Medical Association. Chinese guidelines for the prevention and treatment of type 2 diabetes(version 2017)[J]. Chin J Diabetes,2018,10(1):4-67.(in Chinese)中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
    [8] Chinese Society of Endocrinology,Chinese Medical Association. Expert consensus on the management of hypoglycemia in Chinese patients with diabetes[J]. Chin J Endocrinol Metab,2012,28(8):619-623.(in Chinese)中华医学会内分泌学分会.中国糖尿病患者低血糖管理的专家共识[J].中华内分泌代谢杂志,2012,28(8):619-623.
    [9] YANG XL,CHEN L,LI LH,et al. Analysis of the causes of hypoglycemia after the endoscopic variceal ligation in patients with liver cirrhosis[J/CD]. Chin J Gastrointestinal Endoscopy(Electronic Edition),2017,4(3):114-118.(in Chinese)杨小莉,陈丽,李罗红,等.肝硬化患者内镜下食管静脉曲张套扎术后低血糖原因分析[J/CD].中华胃肠内镜电子杂志,2017,4(3):114-118.
    [10] ZHAO J,LI J,YU HW,et al. Characteristics of energy metabolism in patients of hepatitis B virus related liver cirrhosis with type 2 diabetes mellitus[J]. Parenter Enteral Nutr,2015,22(1):6-9.(in Chinese)赵娟,李娟,于红卫,等.乙型肝炎肝硬化合并2型糖尿病病人能量代谢特点的研究[J].肠外与肠内营养,2015,22(1):6-9.
    [11] LIN M,YANG M,ZHANG M,et al. Clinical significance of delayed peak of insulin release in diabetics and its correlation with function of islet beta cell[J]. Pract J Clin Med,2011,8(6):83-85.(in Chinese)林敏,杨明,张敏,等.糖尿病患者胰岛素释放峰值后移的临床意义及其与胰岛β细胞功能的相关性研究[J].实用医院临床杂志,2011,8(6):83-85.
    [12] HUI W,XU B,GUO XH. Clinical study on glucose metabolic disorder in patients with diabetes and chronic hepatitis B virus infection[J]. J Clini Hepatol,2012,28(7):538-541.(in Chinese)惠威,徐斌,郭新会.乙型肝炎病毒相关的肝源性糖尿病糖代谢异常的临床分析[J].临床肝胆病杂志,2012,28(7):538-541.
    [13] REN GJ,HAN L,QIN SY,et al. Clinical significance of fasting C-peptide combined with fibrosis-4 index in assessing the progression of liver fibrosis in type 2 diabetic patients with nonalcoholic fatty liver disease[J]. J Clin Hepatol,2018,34(12):2582-2586.(in Chinese)任桂晶,韩琳,秦少游,等.空腹C肽联合FIB-4指数对2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化进展的评估价值[J].临床肝胆病杂志,2018,34(12):2582-2586.
    [14] TANG B,CHEN YQ,WANG HF. New concept of parenteral nutrition in patients with liver failure and decompensated cirrhosis[J]. Infect Dis Info,2010,23(2):111-115.(in Chinese)汤勃,陈玉琪,王慧芬.肝衰竭和失代偿期肝硬化患者肠外营养新理念[J].传染病信息,2010,23(2):111-115.
    [15] OLVEIRA G,TAPIA MJ,OCON J,et al. Prevalence of diabetes,prediabetes,and stress hyperglycemia:Insulin therapy and metabolic control in patients on total parenteral nutrition(prospective multicenter study)[J]. Endocr Pract,2015,21(1):59-67.
    [16] KLEK S. Hypoglycemia in hospitalized patients receiving parenteral nutrition[J]. Nutrition,2015,31(2):413-414.
    [17] OLVEIRA G,TAPIA MJ,OCON J,et al. Hypoglycemia in noncritically ill patients receiving total parenteral nutrition:A multicenter study[J]. Nutrition,2015,31(1):58-63.
    [18] LI LY,LI SY,BAI XJ,et al. An analysis of nosocomial hypoglycemia in patients with type 2 diabetes[J]. J Pract Diabetol,2013,9(1):41-44.(in Chinese)李龙英,李世云,白秀娟,等.2型糖尿病患者院内低血糖状况分析[J].实用糖尿病杂志,2013,9(1):41-44.
    [19] HU J,JIANG HP. Hypoglycemia in a patient treated with total parenteral nutrition without insulin:A case report[J]. Parenter Enteral Nutr,2009,16(4):253-256.(in Chinese)胡军,姜海平.全肠外营养液中未加胰岛素并发低血糖1例[J].肠外与肠内营养,2009,16(4):253-256.
    [20] LI XM,LIN J,LI Y,et al. Pharmaceutical care for parenteral nutrition support in a liver cirrhosis patient with gastrointestinal bleeding[J]. China Pharmacy,2017,28(32):4569-4571.(in Chinese)李晓明,蔺洁,李尧,等.1例肝硬化合并上消化道出血患者肠外营养支持的药学监护[J].中国药房,2017,28(32):4569-4571.
    [21] FAN LY. Measures to prevent hypoglycemic reaction during intravenous infusion of fluid containing insulin[J]. Chin Gen Pract Nurs,2009,7(2):140.(in Chinese)范丽英.静脉输注含胰岛素液体时避免低血糖反应发生的措施[J].全科护理,2009,7(2):140.
    [22] YANG L,PENG CS,CAO YA,et al. Effect of blood glucose control on oxidative stress in patients with refractory diabetes mellitus[J]. Clin J Med Offic,2018,46(1):100-101.(in Chinese)杨璐,彭朝胜,曹悦鞍,等.血糖控制对难治性糖尿病患者氧化应激影响研究[J].临床军医杂志,2018,46(1):100-101.
    [23] DONG XM,WANG LJ,SHEN H,et al. Application of insulin dose adjustment in blood glucose control in patients with type2 diabetes treated by insulin pump[J]. J Jilin Univ:Med Edit,2018,44(6):1280-1285.(in Chinese)董学美,王丽娟,沈鸿,等.胰岛素剂量调整在接受胰岛素泵治疗的2型糖尿病患者血糖控制中的应用[J].吉林大学学报:医学版,2018,44(6):1280-1285.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (1333) PDF downloads(214) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return